If you're trying to bill for venography withpacemaker insertion or implantable cardioverter defibrillator (ICD) insertion, you could be unbundling.

A number of providers have tried to bill CPT Codes 36005 (Injection procedure forextremity venography [including introduction of needle or intracatheter]) and 75820 (Venography, extremity, unilateral, radiological supervision and interpretation) with pacemaker or ICD insertion procedures.

The National Correct Coding Initiative doesn't bundle either of those codes into pacemaker/ICD insertion codes, but that still doesn't mean you can bill them routinely with those procedures, say experts.

"There aren't any CCI edits, but there are Medicare guidelines saying you can't bill for inherent services that are routine," notes consultant Terry Fletcher with McVey Associates in Laguna Beach, CA. There is no way to provide a pacemaker without performing a venography at the same time. You use a fluoroscopically guided catheter to insert the pacemaker.

If you're considering billing for venography separately, you should first consider the risk of billing for a routine and inherent service to obtain a mere $18, warns Fletcher. And some commercial payers actually will bundle 36005 and 75820 into pacemaker/ICD insertion codes, notes coder Deborah Craven with the Harbin Clinic in Rome, GA.

Exceptions: You should only bill for venography separately if the physician had difficulty getting at the vein and it caused more complexity, says coder JenniferKelchen with Cardiologists PC in Cedar Rapids, IA. You may need to bill for these diagnostic studies separately if the physician encounters intravenous blockages after trying to advance the electrode for the pacemaker or ICD.

Also, if a patient has had a pacemaker for a long time, the physician may need to perform a separate venography to make sure the patient can tolerate having another lead down there, notes Anne Karl, coding and compliance specialist with the St. Paul Heart Clinic in Mendota Heights, MN. But the bottom line is you shouldn't be billing for venography all the time alongside pacemaker or ICD insertion.